NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic.

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1 bring together all NICE guidance, quality standards and other NICE information on a specific topic. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published. To view the latest version of this pathway see: Pathway last updated: 16 February 2016 This document contains a single pathway diagram and uses numbering to link the boxes to the associated recommendations. All rights reserved

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3 1 Person with suspected ADHD No additional information 2 Principles of treatment and care Respect, understanding and consent Develop a trusting relationship with all people with ADHD and their families or carers by: respecting their knowledge and experience of ADHD being sensitive to stigma concerning mental illness. During assessment and care of children or young people with ADHD: allow them to give their own account of how they feel; record this in the notes involve them and their family or carer in treatment decisions take into account treatment expectations, so that parents or carers or the young person can give informed consent before treatment starts be able to assess a young person's understanding of issues about ADHD and its treatment (including Gillick competence). Work with children and young people with ADHD and parents or carers to anticipate major life changes (such as puberty, starting school, or birth of a sibling) and arrange personal and social support. Consider psychological treatment at these times. Be familiar with local and national guidelines on confidentiality and the rights of the child, parental consent and responsibilities, child protection issues, the Mental Health Act (2007) and the Children Act (1989). Providing information Provide relevant, age-appropriate written information to people with ADHD and their families and carers about diagnosis, assessment, support, self-help, psychological treatment, drug treatment and possible side effects. Give adults with ADHD written information about local and national support groups and voluntary organisations. Page 3 of 10

4 NICE has written information for the public explaining its guidance on ADHD. Carer support Ask families or carers about the impact of ADHD on themselves and other family members and discuss their concerns. Offer families or carers an assessment of their personal, social and mental health needs. Encourage participation in support and self-help groups if appropriate. Advise about positive parent and carer child contact, clear and appropriate rules about behaviour and structuring the child or young person's day. Explain that parent-training/education programmes aim to optimise parenting skills to meet the above-average parenting needs of children and young people with ADHD and do not necessarily imply bad parenting. For more information about parent-training/education programmes, see behavioural and psychological interventions in children in this pathway. 3 ADHD in children and young people See Attention deficit hyperactivity disorder / Attention deficit hyperactivity disorder in children and young people 4 Transition to adult services Reassess a young person treated in CAMHS or paediatric services at school-leaving age to determine if treatment needs to be continued. If it does, arrange for transition to adult services (usually by age 18), giving details of the anticipated treatment and services required. Consider a formal meeting involving CAMHS and/or paediatrics and adult psychiatric services. Give the young person information about adult services and involve them, and when appropriate their parent or carer, in the planning. Use the care programme approach for young people aged 16 years and older. After transition, carry out an assessment of personal, educational, occupational and social functioning, and coexisting conditions, especially drug misuse, personality disorders, emotional problems and learning difficulties. Page 4 of 10

5 For more information about drug misuse, see the drug misuse pathway and for more information about personality disorders, see the personality disorders pathway. 5 ADHD in adults See Attention deficit hyperactivity disorder / Attention deficit hyperactivity disorder in adults 6 Training Trusts should ensure that specialist ADHD teams for children, young people and adults jointly develop age-appropriate training programmes for the diagnosis and management of ADHD for mental health, paediatric, social care, education, forensic and primary care providers and other professionals who have contact with people with ADHD. Child and adult psychiatrists, paediatricians and other child and adult mental health professionals (including those working in forensic services) should undertake training so that they are able to diagnose ADHD and provide treatment and management according to this pathway. The Department for Education should consider providing more education to trainee teachers about ADHD by working with the Teaching Agency and relevant health service organisations to produce training programmes and guidance for supporting children with ADHD. 7 Organisation and planning of services Multidisciplinary specialist ADHD teams Mental health trusts, and children's trusts that provide mental health/child development services, should form multidisciplinary specialist ADHD teams and/or clinics for children and young people and separate teams and/or clinics for adults. These teams and clinics should have expertise in the diagnosis and management of ADHD, and should: provide diagnostic, treatment and consultation services for people with ADHD who have complex needs, or where general psychiatric services are in doubt about the diagnosis and/ or management of ADHD put in place systems of communication and protocols for information sharing among paediatric, child and adolescent, forensic, and adult mental health services for people with ADHD, including arrangements for transition between child and adult services Page 5 of 10

6 produce local protocols for shared care arrangements with primary care providers, and ensure that clear lines of communication between primary and secondary care are maintained ensure age-appropriate psychological services are available for children, young people and adults with ADHD, and for parents or carers. The size and time commitment of these teams should depend on local circumstances (for example, the size of the trust, the population covered and the estimated referral rate for people with ADHD). Multi-agency groups Every locality should form a multi-agency group, with representatives from multidisciplinary specialist ADHD teams, paediatrics, mental health and learning disability trusts, forensic services, CAMHS, the Children and Young People's Directorate including education and social services, parent support groups and others with a significant local involvement in ADHD services. The group should: oversee implementation of this pathway start and coordinate local training initiatives, including training and information for teachers about the characteristics of ADHD and its basic behavioural management oversee the development and coordination of parent-training/education programmes consider compiling a comprehensive directory of information and services for ADHD including advice on how to contact relevant services and assist in the development of specialist teams. Page 6 of 10

7 Glossary ADHD attention deficit hyperactivity disorder BNF British National Formulary CAMHS Child and Adolescent Mental Health Services CBT cognitive behavioural therapy Children between 3 and 11 years Child between 3 and 11 years Concerta XL brand of modified-release methylphenidate; Concerta XL is licensed up to 54 mg Domains a type of social or personal functioning in which people ordinarily achieve competence, such as achievement in schoolwork or homework, dealing with physical risks and avoiding common hazards, and forming positive relationships with family and peers Diversion where the drug is passed on to others for non-prescription use Page 7 of 10

8 DSM-IV Diagnostic and Statistical Manual of Mental Disorders 4th edition ECG electrocardiogram Equasym XL brand of modified-release methylphenidate IR-MPH immediate-release methylphenidate ICD-10 International Classification of Mental and Behavioural Disorders 10th revision Impairment psychological, social and/or educational or occupational impairment Medikinet XL brand of modified-release methylphenidate Moderate ADHD when symptoms of hyperactivity/impulsivity and/or inattention, or all 3, occur together and are associated with at least moderate impairment in multiple settings and multiple domains SENCO special educational needs coordinator Settings home, school, work or a healthcare setting Page 8 of 10

9 Severe ADHD corresponds approximately to the ICD-10 diagnosis of hyperkinetic disorder. This is when inattention, impulsivity and hyperactivity are all present in multiple settings, and when impairment is severe, affecting multiple domains in multiple settings Young people between 12 and 18 years Young person between 12 and 18 years Sources Attention deficit hyperactivity disorder: diagnosis and management (2008 updated 2016) NICE guideline CG72 Your responsibility The guidance in this pathway represents the view of NICE, which was arrived at after careful consideration of the evidence available. Those working in the NHS, local authorities, the wider public, voluntary and community sectors and the private sector should take it into account when carrying out their professional, managerial or voluntary duties. Implementation of this guidance is the responsibility of local commissioners and/or providers. Commissioners and providers are reminded that it is their responsibility to implement the guidance, in their local context, in light of their duties to avoid unlawful discrimination and to have regard to promoting equality of opportunity. Nothing in this guidance should be interpreted in a way which would be inconsistent with compliance with those duties. Copyright Copyright National Institute for Health and Care Excellence All rights reserved. NICE copyright material can be downloaded for private research and study, and may be reproduced for educational and not-for-profit purposes. No reproduction by or for commercial organisations, or for commercial purposes, is allowed without the written permission of NICE. Page 9 of 10

10 Contact NICE National Institute for Health and Care Excellence Level 1A, City Tower Piccadilly Plaza Manchester M1 4BT Page 10 of 10